The Physical Pain of Depression

Imagine you are a busy M.D. with a full schedule of patients. One patient complains of backache and headache. Others have aches in the stomach, joints or muscles. Would you consider depression as a possible cause of this pain?

Remarkably, at least three out of every four patients with depression never mention anything but their body aches when they visit their general practitioner. This is troubling for both the patients and the doctors, as unless the doctor specifically asks about your mood, your depression could go undetected and undiagnosed.

Physical pain associated with depression is a well documented, but an often-forgotten, symptom. Estimates suggest that 50 to 90 percent of patients with depression have physical pains such as these. And that adds up to a whole lot of body aches in the nearly 15 million adults in the U.S. who live with major depressive disorder. Other examples include that people with depression are more then three times as likely to suffer from migraine headaches. And some estimates suggest people with chronic back pain are at a four times greater risk for having depression.

The implications of these statistics are serious. If someone with unrecognized depression leaves the doctor’s office with pain medication only, they are likely to remain depressed and possibly at risk for suicide.

Some physical symptoms of depression include:

Headaches

Stomach/digestive problems

Muscle/joint aches

Chest pain

Dizziness/lightheadedness

Fatigue

Change in libido

Sleeplessness or excessive sleeping

Weight gain or loss/change in appetite

Fortunately, when it is recognized, depression is a highly treatable disease. Most patients who receive treatment for depression also often report that their physical pain decreases as their mood improves. Antidepressant medications that increase levels of the neurotransmitters serotonin and/or norepinephrine can bring about often life-saving improvement. These two chemical messengers not only regulate mood by their actions in the brain, they also modulate pain signals coming from the rest of the body. This also is consistent with the fact that antidepressants also help relieve pain associated with diabetic neuropathy.

Interestingly according to Harvard Health, "Almost every drug used in psychiatry can also serve as a pain medication. Relieving anxiety, fatigue, depression, or insomnia with mood stabilizers, benzodiazepines, or anticonvulsants will also ease any related pain." For example, the FDA just recently approved the antidepressant drug Cymbalta to help chronic back pain sufferers.

Of course, the depression-pain connection can also be a pain-depression connection. Severe, long-lasting, chronic pain can weigh people down until their mood falls into clinical depression. In these cases, successfully treating the source of the pain may help relieve the depression.

Depending on your situation, you may need treatments for depression, pain or both. The most important thing is that if you have unexplained aches and/or feel depressed, talk to your doctor about them. Getting treatment as early in the pain-depression cycle as possible is important. You can limit your suffering by using a combination of antidepressant medications, psychotherapy and stress-reduction techniques.